Dr Birgit Greiner, University College Cork, Department of Epidemiology & Public Health

Transcription

1 Dr Birgit Greiner, University College Cork, Department of Epidemiology & Public Health

2 Take a scientific perspective on the issue of work-related musculoskeletal disorders (WRULDs) Critically discuss common assumptions about MSD injuries Focus on psychosocial risk factors for WRMSDs What are psychosocial risk factors? Risk management approach Training transfer in the context of WRMSDs and psychosocial factors Research examples and evidence

3 The term ivory tower originates in the Biblical Song of Solomon From the 19th century it has been used to designate a world or atmosphere where intellectuals engage in pursuits that are disconnected from the practical concerns of everyday life. It usually carries pejorative connotations of a wilful disconnect from the everyday world; esoteric, over-specialized, or even useless research, and academic elitism. Source: Down to the basics

4 The scientific perspective has to offer: o Theory with application to practice o Research findings to inform practice There is nothing so practical as a good theory. (Kurt Lewin, , German Professor in Psychology and Philosophy)

5 Work-related musculoskeletal injuries are mainly caused by manual handling problems. Proper training in manual handling will solve the problem. Most injuries are caused because people behave in the wrong way. Many MSD problems are caused by poor ergonomic work design. We just have to educate people about the negative effects of unsafe behaviour and they will change their behaviour.

6 High force Repetition Poor posture Work-related musculoskeletal disorders Traumatic or cumulative Vibration Rest breaks Low temperatures

7 those aspects of the design and management of work and its social and organisational contexts, that have the potential for causing psychological and physical harm (Leka, Cox & Zwetsloot, 2008, p.2). Psychosocial hazards are often discussed in the context of work stress.

8 Work demands, high effort Work control, decision latitude Social support from supervisors and peers Work-related musculoskeletal disorders Mainly cumulative Role conflict, uncertainty Missing rewards Job future ambiguity, change

9 Are often thought to be Individual, response different for everybody, Subjective as opposed to the objective environment Related to mental health issues In the minds of people Nebulous From a risk management approach Collective, response similar for people Objective characteristic of the work Can affect mental and physical health In the work environment Can be clearly described and risk assessed

10 Are a hazard as any other hazard Are due to the design and management of work and working conditions Can be risk assessed (e.g. HSA Work Positive tool) Can be managed and their risks can be controlled in the same way as any other hazard. Note: The risk management approach originates in occupational safety and health Be aware of other views: For example, stress as as individual, subjective from the psychological perspective

11 Health and Safety Authority Ireland Work Positive, Prioritising Organisational Stress is an audit tool or survey for employees. It contains the Management Standards approach pioneered by the Health and Safety Executive in the UK. It is a user-friendly process and is downloadable from the HSA website, where more information is contained. Workplace Contact Unit:

12 The two main models used in research on the effects of psychosocial risk factors at work and WRULDs: Demand Control Model Effort - Reward Imbalance Model Both models assume: Psychosocial risk factors often work in combination

13 Psychological Demands Low High Learning, motivation to develop new behavior patterns Decision Latitude High Low Strain Active Jobs Low Passive Jobs High Strain Risk of psychological strain and physical illness

14 demands / obligations - labour income - career mobility / job security - esteem, respect reward effort motivation ( overcommitment ) motivation ( overcommitment ) 14

15 A combination of high demands and low control (or decision latitude) leads to most strain. It is a situation where workers have a lot to do without the flexibility of adjusting the timing, the work load itself or the way work is done. This model has been widely used in occupational health research. High strain job have been associated with many negative health outcomes including heart disease, stroke, MSDs, mental health and other health conditions.

16 The most stressful jobs are those that high work-related demands that require high levels of effort coupled with low control over job-related rewards (e.g. recognition, peer esteem, pay) triggers high levels of activation. People with high effort and low rewards develop over-commitment striving towards recognition by putting in more and more effort. The model was also widely used in international occupational health research with scientific evidence that a high ERI is associate with heart disease and mental health issues.

17 Objective of the study: Are differences in physical workload, psychosocial work factors and musculoskeletal disorders attributable to work organizational factors? Study group: Cleaners in hospitals Cleaners are known to have a high rate of musculoskeletal disorders

18 The study compared 2 groups with different types of work organisation: traditional and extended work organisation Traditional organisation (24) Extended organisation (22) Group size Large groups: 20 Small groups: 6-8 Management Supervisor Group leader Authority Limited: rules by cleaning schedules Group-based agreements Working area Individual and shattered Group-based and coherent Work content Cleaning Cleaning, planning, client contacts Support training Induction 2-4 h Induction 2-4 h Further training - In total 40 h Feed back Scarce and individual Frequent and group-based Unge J. et al. Differences in physical workload, psychosocial The psychosocial factors and musculoskeletal side - Back-to-Basics- disorders between 2 groups of female hospital cleaners. Int. Arch Occup Environ Health, 2007, 81:

19 The extended work organisation group had: Lower physical load Lower physical work load (heart rate ratio), Lower muscular load (head and upper arms positions and movements and wrist movements) measured by electromyography and accelerometers Lower psychosocial factors: Reported higher decision latitude Reported lower work demands No difference in reported social support Lower MSDs: Less complaints (physically examined) in neck/shoulder Less clinical diagnoses in neck/shoulder and elbows/hands 7 times lower frequency of overuse hand syndrome Note: Both groups were equal in terms of age, employment time, immigration status and several individual traits tension tendency and subjective stress worries.

20 The way work is organised can play a big role. The work organisation can affect both: o Physical risk factors o Psychosocial risk factors Which in turn can both influence musculoskeletal health

21 Psychosocial work risk factor Stress responses Physiological : stress hormones Increased activation Behavioural: changed life style, risk taking Cognitive: scattered thinking, preoccupied with worries Decreased pain threshold, tension, increased vulnerability Unsafe behaviours to cut corners, smoking and overeating to cope with stress feelings Lapse of attention and concentration Emotional: nervousness, anxiety Increased muscle tension, over alertness

22 Physical risk factors Repetition, heavy loads, awkward postures Biomechanical load Work-related MSDs Psychosocial risk factors High demands, low job control, low support, low rewards Psychosocial pathways Work-related MSDs

23 The biomechanical approach: based on the premise that physical job aspects contribute to MSDs. Two main mechanisms: excessive load and repetitive loading on the spinal structures The psychosocial approach: social and work organision job aspects contribute to MSDs. Three main mechanisms: o o o Higher loading on spine via changes in the forces exerted and higher muscle tension Chemical reactions: muscle tension reduces blood flow, increased vulnerability of muscle through stress hormones Altered tolerance to pain

24 HITS Study: Hand-Intensive Tasks Health and Safety Sheilah Nolan, Birgit Greiner, Dervla Hogan Study with Chartered Irish Physiotherapists, physical therapists and sports therapists University College Cork, IOSH-funded

25 To generate a scientific evidence base for the development of an effective health and safety strategy to prevent upper limb disorders in handintensive healthcare occupations and to give recommendations for the development of a guidance document. HITS Study

26 Hand-intensive health care workers have a high prevalence of ULDs and back symptoms and injuries, despite the irony that they treat patients with MSDs Associations with physical work factors are well researched, e.g. o Manual handling issues o Physically strenuous treatment techniques o Working hours o Ergonomics Less is known about psychosocial hazards at work, for example work organisation factors

27 It is not work but the lifestyle that causes MSDs People bring their injuries from sporting accidents or leisure time injuries into the job. Mental health and mood issues make people sick or make people report more sickness. It s age and wear-and tear.

28 Sampling CHARTERED PHYSIOTHERAPISTS Self-employed: Random sampling of online data base Hospital employed: One-stage proportionate cluster sampling in different hospitals PHYSICAL THERAPISTS Graduation database of the Institute of Physical Therapy and Applied Science + membership list Irish Association of Physical Therapists 133/248 54% 71/226 31% 152/199 76% SPORTS/ATHLETICS THERAPISTS Membership list of Athletic Rehab Therapy Certified (A.R.T.C.) 13/18 72%

29 Socio-demographics Musculoskeletal health o o Upper limb symptoms: in last 7 days, in last 12 months, incapacitating symptoms in last 12 months (Nordic questionnaire) Self-reported upper limb disorder medical diagnoses (following consensus statement (Harrington et al., 1998) Work risk factors and resources o o o Psychosocial: Work demands, tempo, predictability, influence (Copenhagen Psychosocial Questionnaire) Physical: physical exertion (Borg, 1970), force, repetition, posture (Spielholz, Silverstein & Stuart, 1999) Organisational/temporal: rest breaks, input in scheduling Alternative explanatory factors (confounders) o Body mass index, smoking status, General Health (GHQ12 questionnaire) (Goldberg & Hillier, 1997), leisure time MSD injury, age, gender, work load

30 Males 33%, females 67% Employed 42%, self-employed 58% Mean age= 39 (std. 8.82), range: Experience as therapist: <5 years: 26%; 5-10 yrs: 27%; yrs: 19%; yrs:9%; >20 yrs: 19% Hours per week in manual therapy: 1-10 hrs: 29% ; hrs: 33% hrs: 22% hrs: 11%; 40 hrs+: 5% Average number of clients/patients per day: 9 (range: 1-29; std=4.5)

31 shoulder neck elbow wrist finger thumb any 12-month prevalence 7-day prevalence 12-month prevalence of incapacitating symptoms 25.6

32 Those who used an electronic booking system or an assistant for scheduling were more than twice as likely to have had UL symptoms in past year. Likely explanation: o o o Can vary clients Can vary load on particular body parts Can adjust emotional demands ( challenging clients ) Alternative explanations were ruled out in the statistical analyses such as socio-demographics, number of patients/day, treatment length, hours of manual therapy/day, life-style related issues, previous leisure time injury and mental health

33 Those who took on average less than 5 minutes rest break after treating a client were more than twice as likely to report ULD symptoms than those who took 5 minutes or longer. The higher o o o o Predictability of work Influence at work Peer support Supervisor support the lower the 12 month prevalence of incapacitating upper limbs symptoms after ruling out alternative explanations No association with work demands or work tempo.

34 Those who had injury prevention training were 30% less likely to suffer from incapacitating symptoms in the past 12 months. NO clear association with non-incapacitating symptoms. Again, this was adjusted for main alternative explanations. Those with risk assessment at work were 60% less likely to have any UL symptom in past 12 month.

35 High prevalence of UL symptoms and incapacitating symptoms especially of shoulder, neck and thumb. Psychosocial work factors (predictability, influence, social support) showed a clear protective against ULDs Rest breaks and input into scheduling emerged as important work organisation factors Risk assessment crucial Injury prevention training and risk assessment appear to be protective for 12-month UL prevalence but not for incapacitating symptoms Alternative explanations were ruled out: demographics, previous leisure time injury and other life style-related, mental health, and job age, occupational group.

36 Guidance document: Guidance on task-specific risk assessment including also psychosocial and work organisation factors Specific guidance on rest breaks Concrete scenarios on how to have input into work scheduling and control over work timing Continued education and injury prevention training Specific issues for self-employed therapists

37 Does training automatically result in behaviour change? No!!! Does knowledge automatically translate into behaviour? No!!! Effective and continuing application in the job environment of skills and knowledge gained in the training context (Baldwin & Ford, 1988)

38 Goals No injuries Technique

39 Transfer and maintenance Training Skills Knowledge Put learned behaviour into practice Short-term Long-term Low injury and MSD rates Scientific evidence?

40 Transfer and maintenance Training Skills Knowledge Put learned behaviour into practice Short-term Long-term Low injury and MSD rates Systematic reviews: Very little evidence for an association between Manual handling training and injury/disorder rates. SA Clemes, CO Haslam What constitutes effective manual handling training- Occupational Medicine, Soc Occupational Med

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42 Transfer and maintenance Training Skills Knowledge Put learned behaviour into practice Short-term Long-term Low injury and MSD rates Another systematic review: Training behaviour change injury rates: DAM Hogan, BA Greiner, L O'Sullivan The effectiveness of manual handling training on achieving training transfer and employee behaviour change and subsequent reduction of work-related MSDs Ergonomics, 2014

43 Reviewed the most robust studies of high scientific quality (Randomised Controlled Trials) Included both manual handling and patient handling training Internationally 13 articles published in peer-reviewed scientific journals Results: Scarce research with focus on training transfer No robust scientific evidence that manual handling results in behaviour change and/or reduce WRMSDs Some evidence for heightened awareness of participants shortly after training

44 Manual handling/patient handling training not useful? No, manual handling training is definitely useful However research points to several issues we need to further investigate: o Training transfer: Does it happen? When does it happen? o Long-term behaviour change/ versus short-term o Barriers and facilitators to safe behaviours In immediate work task In work environment, the culture

45 Trainee characteristics Intelligence, learning style Attitude Motivation Experience Training and trainer characteristics How close to practical work environment, relevance, structure Transfer of training model by Baldwin and Ford(1988) Transfer climate Supervision Reinforcement Support Recognition Technical environment

46 Other models specifically address the training transfer environment or climate. There can be facilitating and inhibiting factors in an organisation for training transfer. Foxon M. A process approach to the transfer of training. AJET, 1993, 9(2),

47 Socio-economic national level Recession National priorities Company/unit level Work context Safety climate, supervisor support Work task level Systems of work Work organisation Job demands, job control Personal level Personality Attitudes Coping styles

48 Our job is not done with training Training transfer and creating a supportive environment for transfer Monitoring and evaluation of training success necessary Work organisation factors at the core of preventing WRMSDs o To control physical exposures o To control psychosocial exposures More training and capacity building in risk assessment and management of psychosocial hazards

49 Thank you for your attention. Questions